Provider Demographics
NPI:1235162637
Name:NARATADAM, GEORGE JOSE (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:JOSE
Last Name:NARATADAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:
Practice Address - Street 1:675 W NORTH AVE STE 510
Practice Address - Street 2:NEPHROLOGY ASSOCIATES OF NORTHERN ILLINOIS
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1626
Practice Address - Country:US
Practice Address - Phone:708-450-4551
Practice Address - Fax:708-681-9711
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120166207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036120166Medicaid
IL922820007Medicare PIN
IL036120166Medicaid